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International Angiology 2013 October;32(5):512-17


language: English

Role of an intermittent claudication questionnaire for the diagnosis of PAD in ambulatory patients with type 2 diabetes

Mancera-Romero J. 1, Rodríguez-Morata A. 2, Angel Sánchez-Chaparro M. 3, Sánchez-Pérez M. 1, Paniagua-Gómez F. 1, Hidalgo-Conde A. 3, Valdivielso P. 3, 4

1 Centro de Salud “Ciudad Jardín”, Servicio Andaluz de Salud, Málaga, Spain; 2 Servicio de Angiología y Cirugía Vascular, Hospital “Virgen de la Victoria”, Málaga, Spain; 3 Servicio de Medicina Interna, Hospital “Virgen de la Victoria”, Málaga, Spain; 4 Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain


Aim: In epidemiological studies, peripheral arterial disease is assessed by the measurement of the ankle/brachial index (ABI), thus enabling detection of asymptomatic disease. Our aim was to evaluate the diagnostic accuracy of a validated questionnaire on intermittent claudication for peripheral arterial disease in a clinical setting.
Methods: We administered the Edinburgh questionnaire on intermittent claudication and measured ABI using a portable Doppler in 456 outpatients with type 2 diabetes. Subjects with intermittent claudication and an ABI above 0.9 were examined with color Doppler ultrasound imaging. Peripheral arterial disease was considered to be present when the ABI was <0.9 or the color Doppler arterial waveform was monophasic.
Results: Thirty-five (7.6%) of the 456 patients had intermittent claudication. Of these, 22 (63%) had an ABI <0.9 and the remaining 13 (37%) had an ABI >0.9. Of these latter, 12 were reexamined and 3 (25%) were found to have monophasic waveforms in color Doppler, thus being diagnosed with peripheral arterial disease. The overall accuracy of intermittent claudication for peripheral arterial disease was 75% (95% CI, 71-79).
Conclusion: Among patients with type 2 diabetes, a normal ABI does not rule out peripheral arterial disease; the use of an intermittent claudication questionnaire is able to identify correctly the disease in 3 out of 4 patients with diabetes. Our results suggest incorporating the intermittent claudication questionnaire into the general consultation instead of the general screening of the ABI.

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